Seizures and Anti-Epileptic Medications

These flashcards cover key concepts related to seizures, their classifications, treatment options, potential side effects of anti-epileptic drugs, and guidance on pregnancy and driving.

What is a seizure?

A transient occurrence of signs/symptoms due to abnormal excessive or synchronous neuronal activity in the brain.

What are the two categories of seizures?

Focal and Generalized.

How do focal seizures differ from generalized seizures?

Focal seizures originate in brain networks limited to one lobe or hemisphere, while generalized seizures originate in bilaterally distributed networks.

What is the first-line treatment for focal seizures?

Lamotrigine or Levetiracetam.

Which medication is used as a first-line treatment for pure absence seizures?

Ethosuximide.

Which medication is used as a second-line treatment for pure absence seizures?

Sodium valproate

When should sodium valproate not be initiated in patients?

If the patient is under 55 years of age, unless specified by a specialist.

What is the significance of status epilepticus?

It refers to a seizure lasting more than 5 minutes, requiring resuscitation and immediate emergency treatment.

What should be done if a seizure does not stop within 5-10 minutes?

Administer a second dose of benzodiazepam.

What are the categories of anti-epileptics based on brand consistency?

Category 1 must be the same brand; Category 2 varies by clinical judgment; Category 3 has no need to maintain the same brand.

What are some high-risk side effects associated with Carbamazepine, Phenytoin, and Sodium Valproate?

High-risk side effects include depression, suicidal ideation, hepatotoxicity, blood dyscrasias, skin disorders, and vitamin D deficiency.

What are common side effects of Lamotrigine?

Stevens-Johnson syndrome.

What should be done regarding pregnancy if a patient is on sodium valproate?

Women of childbearing potential must be on an effective contraception plan and part of a pregnancy prevention program.

What is the guideline for driving after a seizure?

Notify the DVLA and stop driving immediately; reapply if no seizures occur for one year.

What tests are used to determine risk after the first seizure?

Electroencephalogram (EEG), MRI scans, and genetic testing.

What medications are in Category 1 of anti-epileptics?

Carbamazepine, Phenytoin, and Sodium Valproate must be the same brand.

What medications are in Category 2 of anti-epileptics?

Includes Lamotrigine and Levetiracetam, which vary by clinical judgment.

What medications are in Category 3 of anti-epileptics?

Includes others without the need to maintain the same brand.

What are the therapeutic ranges for Carbamazepine?

Therapeutic range is typically 4-12 mcg/mL.

What are the therapeutic ranges for Phenytoin?

Therapeutic range is generally 10-20 mcg/mL.

What are signs of toxicity for Carbamazepine?

Signs include dizziness, unsteady gait, nausea, and visual disturbances.

What are signs of toxicity for Phenytoin?

Signs include nystagmus, ataxia, and confusion.

What are some high-risk side effects associated with Carbamazepine, Phenytoin, and Sodium Valproate?

High-risk side effects include depression, suicidal ideation, hepatotoxicity, blood dyscrasias, skin disorders, and vitamin D deficiency.

What are common side effects of Lamotrigine?

Stevens-Johnson syndrome is a significant risk.

What should women of childbearing potential do if they are on sodium valproate?

They must be on an effective contraception plan and participate in a pregnancy prevention program.

What medication interactions should be considered with anti-epileptics?

Be cautious with medications that induce or inhibit hepatic enzymes, as they can affect anti-epileptic drug levels.

What advice should be given regarding breastfeeding while on anti-epileptics?

Consult a healthcare provider, as some medications can be excreted in breast milk and affect the infant.